Wednesday, January 31, 2018

When I moved to Rome I resigned
myself to getting fat. To my surprise, a year later I had lost 10 pounds.

My new shape blended in with my
surroundings. Italians are lately the second-thinnest people in Europe, next to
the French; a woman who’s medium-sized by American standard is hard put to find
clothes she can squeeze into in Rome boutiques.

How do they stay slender while tucking away all
that pasta, olive oil, and gelato? Chiefly, because their attitude toward food
is, well, normal. They eat three
squares rather than constantly stuffing their faces, they savor their food
instead of packing it in, they cherish the collective mealtime ritual of
sitting down together at length to break bread with family and friends. Grazing
and raiding the refrigerator are concepts as un-Italian as Taco Bell, and six
months living under the disapproving gaze of my mother-in-law until my ex- and
I found an apartment cured me of both.

That cultural norm of eating when
they’re hungry instead of using food as a pacifier means Italians are less
likely to get hooked. Food addiction, once you’ve acquired it, is a
particularly hard habit to shake. Here’s why: it’s common knowledge that
recovering junkies, smokers, or alcoholics have to stay away from their
favorite substance altogether. One sneak fix, one fag after one supper, one
highball will send the slipper-up back to addict hell. Since you can’t both stay
off food and stay alive, the obese are obliged to achieve that impossible goal of
eating – consuming the substance they’re addicted to – in moderation.

The kind of stuff that goes in Italian
mouths counts too, of course. They put real food on their plates rather than
fat- and sugar-packed processed products, quench their thirst with water rather
than soda, love vegetables, and after dinner are more likely to eat a peach in
summer or an orange in winter than a slice of chocolate cake.

I can’t find any reliable statistics
from mid-century, but between watching postwar movies and decades of personally
eyeballing the locals I can guarantee you that skinny hasn’t always been the
rule. When I first sat on Italian beaches in 1970 I was amazed at the plus size
bosoms and bottoms that were wrapped in those skimpy bikinis. Later when
fashions changed, Italians’ sensible food culture made slimming down a relative
cinch: just slash your standard portion of pasta by half, eat one less course
at every meal, and voilà in a decade the
national figure shrank from Rubens to . . . Raphael.P.S. It helps, needless to say, that Italians habitually use their feet instead of their car, and take the stairs without considering it torture!

Wednesday, January 17, 2018

I once had a heart
disease patient named Edoardo, the father of a friend, who had angina pectoris
so severe he couldn’t cross the room without pain. Back then, in 1989,
angioplasty and stenting hadn’t yet been invented, but surgeons did know how to
unplug coronary arteries using open heart surgery and he definitely needed it.
There was only one problem: in Italy at the time bypass surgery meant at least
a one in four chance of dying on the table.

Those were not odds I felt I could
recommend. I turned for help to my trusted cardiologist, the late Alberto De
Feo, who came up with a solution in the form of brand-new European Union
regulations. My patient followed Dr. De Feo’s instructions to the letter. He
drove to Monte Carlo on the French Riviera, stayed three days in a hotel
hanging around the roulette tables, then went to the Emergency Room of a
specific hospital clutching his chest and claiming the pain had just started. He
could – and did – get bypass surgery in France and charge the bill to the
Italian National Health Service, but only if it was a real emergency.

Even now, after thirty years of European
Union rules easing the obstacles to medical country-hopping, such picturesque Emergency
Room theatrics are still not entirely obsolete…

P.S. It was lucky this particular heart
patient was Italian; I think most Americans wouldn’t have managed to carry off
the trick (and might have been more squeamish about its ethics). Pay attention
on any Rome bus and you’ll find at least one native casually improvising
melodrama. The ancient theatricality of Italian culture gets an extra boost
from a school system based on gaming oral examinations in front of an audience…

Sunday, January 7, 2018

One day last October I was sitting at
a computer screen at my office’s reception desk scrolling through the images of
a patient’s CAT scan – my own computer wouldn’t do because I’m an Mac girl and
all radiology CDs in Italy are Windows-only – struggling to keep my
concentration on the patient’s insides and ignore the chaos around me.

My secretary Mariateresa was speaking
into a phone and her voice succeeded in penetrating my defenses. “Robertino
needs his hepatitis B vaccine? No, I’m sorry, there’s no point in taking an
appointment with the pediatrician, because that vaccine is unavailable at the
moment. The Haemophilus influenzae shot? Same story, I’m afraid.” This was so
startling that I abandoned the CAT scan images and indulged my curiosity: “Not
available? How can that be? Those are obligatory vaccines. Kids can’t start
school without them.” Mariateresa shrugged dismissively, “Of course, that’s
exactly the point. Every fall parents scramble to get their kids vaccinated,
and every fall there aren’t enough vaccines to go around. This year the missing
ones are hepatitis and Haemophilus, last year it was meningitis and
measles-mumps-rubella.” If you think about it this kind of shortfall is
inexcusable. Italy has universal population registries, so it could easily
calculate the number of necessary doses ahead of time, but hey that’s our
beloved Bel Paese.

The Italians have a saying about the
marvels of Rome, “Non basta una vita,”
a lifetime is not enough to see them all. Well, the same goes for its foibles –
after 39 years here I’m still encountering new ones.

Generally speaking Italy is a great
country to buy medications: list prices trend low, and anyone with a National
Health Service prescription pays zero or close to. The authorities are able to
swing this by bargaining ruthlessly with the drug companies over prices. Just a
couple of months ago California-based Gilead Pharmaceuticals agreed to accept
$11,000 for each course of hepatitis C treatment with their new pill Epclusa.
That may sound like a lot but it’s far lower than the $75,000 they get in the
States. If Gilead hadn’t agreed to cut the price of Epclusa, it wouldn’t have
been included on the National Health Service formulary and no doctors in Italy
would prescribe it.

The ins and outs of the system keep
us docs on our toes. The yearly vaccine debacle may have been new to me, but I’ve
always known the pharmaceutical supply chain to be iffy. Things change fast. Yesterday you could buy the equivalent of the
tranquilizer Ativan only as generic lorazepam, today there’s only brand-name
Tavor. This week the antibiotic metronidazole is on pharmacy shelves only as
Flagyl, next week only as a generic, the week after only as Deflamon, then for
six months it’s unavailable under any name. During the entire 2013-14
flu season neither of the two approved anti-influenza drugs, Tamiflu and
Relenza, could be found anywhere in Rome. Premarin, the classic hormone pill
and vaginal cream, disappeared mysteriously from Italian pharmacies in 2009 and
has never shown up again. Yes, I know the US runs low on a drug now and then,
but here shortages are too commonplace to warrant a mention in the paper much
less headlines.

Then there’s the way brand names keep
biting the dust. The Italian companies
that make the meningitis vaccine and the one against measles-mumps-rubella change every few years. For a decade
I prescribed menopausal women a rub-it-in estrogen skin gel called Gelestra
(Estrogel in the States), but at the end of 2014 it became Ginaikos – same gel, same pharmaceutical
company, same dose, same formulation, same color box, but pharmacies won’t
dispense it unless my prescription bears the new name.

Almost all medications found in the
US or the UK are on the market here, plus some that either are new and got
approved here first or are left over from the Jurassic era. But like so much
else in Italy, getting hold of a specific drug can sometimes be a crap shoot.
Don’t even consider having your supply shipped from home – it’s close to
impossible to extricate prescription drugs from Italian customs, which is on
the lookout for them.

Moral of the story: if you’re coming
to Italy and there’s a medication you really really need, bring along enough to
last you for the duration.

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.